Introduction to Fractures

Nan-Ying Yu 2005 12 12

Definition
An interruption in the continuity of the bone which may be a complete break or an incomplete break or an incomplete break (crack).

Classification
There are two main types of fracture and various subdivisions which are named according to the position of the fractured parts of the bone

Closed fracture
This type indicates that there is no communication between the external surface of the body and the fracture.

Open fracture
There is a communication between the fracture and the skin. This could occur because the displacement of the bone ends has caused one or both to pierce the skin, or because an external force has pierced the skin, soft tissues, and fractured the bone. This type of fracture is an additional cause for concern because of the possibility of infection.

Types of fracture
Simple fracture Spiral fracture Transverse fracture Oblique fracture Comminuted fracture Greenstick fracture

Causes
Trauma Might be a direct blow *indirect violence such as falling on a hand or foot *caused by repeated minor trauma (stress or fatigue fractures) Pathological fractures *Occur as a result of disease such as carcinoma, osteogenesis imperfecta, Pagers disease and infection.

Clinical features

Immediately after fracture

Shock Pain Deformity Oedema Marked local tenderness Muscle spasm Abnormal movement and crepitus Loss of function

Following reduction and fixation

Pain Oedema Loss of functions

After removal of the fixation

Pain Oedema Limitation of joint movement Weak muscles Loss of functions

Healing of features
Stage of haematoma Stage of sub-periosteal and endosteal cellular proliferation Stage of callus formation Stage of consolidation State of remodelling

Healing of cancellous bone

Union of fractures It depends on the following factors Type of bone Classification of fracture Blood supply Fixation Age Delay union This indicates that healing is taking longer than would normally be expected.

Complications
Infection Avascular necrosis Mal-union (deformity of shortening) Joint disruption Adhesion Injury to large vessels Injury to muscle Injury to nerves Sudecks atrophy Injury to viscera Contracture

Principles of management
First aid The patient should not be moved Possible further fractures should be prevented

Principles of management
Principles of treatment by surgeon In the case of severe injury, there may be other problems that take priority over treatment of the fracture: shock, bleeding, maintenance of airway and ventilation, and possibly other injury. The surgeon will aim to obtain good reduction and alignment of the fracture, followed by immobilization that is sufficient to promote good healing and restoration of function.

Principles of management
Reduction Closed reduction Reduction by traction Open reduction Immobilization External splinting Internal fixation

Physiotherapy during immobilization

Reduce oedema to prevent the adhesion formation Assist the maintenance of the circulation active exercise either by static or isotonic muscle activity Maintain muscle function by active or static contraction Maintain joint range where possible Maintain as much function as allowed by the particular injury and the fixation Teach the patient how to use special appliances such as crutches, sticks, frames, and how to care for these or any other apparatus

Physiotherapy after the removal of fixation

To reduce any swelling To regain full range of joint movement To regain full muscle power To re-educate full function